外科におけるイノベーション

Patients have been relieved from pain by general anesthesia and postoperative mortality has also improved by sterilization in 19th century. Progress in surgical technology improved the patient’ s quality of life. Transthoracic en bloc esophagectomy（TTE）with three-field lymph node dissection is a radical strategy for treatment of esophageal cancer, but the morbidity and mortality are still substantial. With the mediastinoscope, esophagectomy was performed safely under direct vision. There was only a small amount of bleeding, and surgical time was short. Little morbidity and no deaths were recorded.
Total mastectomy and pectoral muscle resection with en bloc axillar lymphadenectomy（Halsted operation）has been the gold standard of breast cancer treatment. Now breast conserving operation with sentinel lymph node biopsy（SLNB）has been becoming the new standard.
We developed a three-dimensional computed tomography lymphography（3D CT-LG）technique with commercially available iopamidol. Preoperative 3D CT-LG performed in patients with breast cancer and superficial esophageal cancer accurately depicted the lymph vessels and the SLNs in all patients. CT-LG allowed accurate direction of the lymph flow and SLN localization by quickly and adequately visualizing the direct connection between the SLN and its afferent lymphatic vessels on detailed cross-sectional images of lymphatic anatomy during the routine CT scan to evaluate distant metastases, thus resulting in successful SLN navigation with saving time and cost.

四国医学雑誌 : http://www.med.tokushima-u.ac.jp/article/0012780.html